Karaciğer sirozu olan hastalarda yürüyüş sırasındaki plantar basınç dağılımı paternleri

Yıl 2016, Cilt: 3 Sayı: 2, 53 - 59, 01.08.2016

Meriç Yıldırım , Nihal Gelecek İlkşan Demirbüken Mesut Akarsu

Öz

Amaç: Periferal nöropatiler, vücut kompozisyonundaki değişiklikler, peritoneal boşluk içinde patolojik sıvı birikimi anlamına gelen asit varlığı, bacak ödemi ve alt ekstremite kas kaybı, karaciğer sirozu olan hastalarda plantar basınç dağılımını etkileyebilecek muhtemel faktörlerdir. Çalışmanın amacı, karaciğer sirozu olan hastalarda dinamik pedobarografik ölçümleri kullanarak, yürüyüş sırasındaki plantar yüklenme özelliklerindeki değişiklikleri belirlemek ve sağlıklı kontrol grubu ile karşılaştırmaktı.

Yöntem: Çalışmaya karaciğer sirozu olan 21 hasta (10 kadın, 11 erkek, ortanca yaş 38 yıl) ve 21 sağlıklı kontrol (11 kadın, 10 erkek, ortanca yaş 36 yıl) alındı. Yürüyüş sırasındaki çıplak ayak plantar basınç dağılımı EMED-M® basınç platformu kullanılarak 10 bölgeden ölçüldü: arka ayak, orta ayak, 1, 2, 3, 4 ve 5. metatarsal baş, baş parmak, ikinci parmak ve 3, 4, 5. parmaklar. Zirve basınç (Newton/cm2) ve Kuvvet-Zaman-Alan İntegrali (Ns/cm2) verileri analiz için kullanıldı.

Bulgular: Sol birinci metatarsal baş ve ikinci parmak zirve basınçları hasta grubunda anlamlı olarak yüksekti (sırasıyla p=0.025 ve p=0.020). Hasta grubunda hem sol hem sağ orta ayak üzerinde Kuvvet-Zaman-Alan İntegrali anlamlı olarak daha yüksekti (p=0.007 ve p=0.017, sırasıyla).

Tartışma: Doku hasarına ilişkin duyarlı bilgi sağlayan Kuvvet-Zaman-Alan İntegrali’nin siroz hastalarının her iki orta ayağında anlamlı olarak yüksek olması, siroz hastalarının ayaklarına günlük klinik pratikte önem gösterilmelidir.

Anahtar Kelimeler

Yürüyüş, Karaciğer sirozu, Plantar basınçlar

Plantar pressure distribution patterns during gait in patients with liver cirrhosis

Öz

Purpose: Peripheral neuropathies, changes in body composition, presence of ascites which means pathologic fluid accumulation in peritoneal cavity, leg edema and lower extremity muscle mass loss are possible factors that may alter plantar pressure distribution in patients with liver cirrhosis. Our aim was to determine the changes in plantar loading characteristics during walking in patients with cirrhosis using dynamic pedobarographic measurements and to compare the results with a healthy control group.

Methods: Twenty-one patients with liver cirrhosis (10 females and 11 males, median age 38 years) and 21 healthy controls (11 females and 10 males, median age 36 years) were included in the study. Barefoot plantar pressure distribution during gait was measured on 10 regions as follows: Hindfoot, midfoot, 1st, 2nd, 3rd, 4th and 5th metatarsal heads, big toe, second toe and toes 3, 4, 5 using an EMED-M® pressure plate. The data of peak pressure (Newton/cm2) and Force-Time-Area Integral (Ns/cm2) were used for the analysis.

Results: Peak pressure on the left first metatarsal head and the second toe were significantly lower in patient group (p=0.025 and p=0.020, respectively). Force-Time-Area Integral on midfoot was significantly higher in patient group on both left and right foot (p=0.007 and p=0.017, respectively).

Conclusion: Force-Time-Area Integral, which provides more sensitive information about risk of tissue damage, was higher on midfoot of both feet in patients with cirrhosis suggesting that feet of the patients need special attention in daily clinical practice.

Anahtar Kelimeler

Gait, Liver cirrhosis, Plantar pressures

Kaynakça

• 1. Rosenbaum D, Becker HP. Plantar pressure distribution measurements. Technical background and clinical applications. Foot Ankle Surg. 1997;3:1-14.
• 2. Van Deursen R. Mechanical loading and offloading of the plantar surface of the diabetic foot. Clin Infect Dis. 2004;39Suppl 2:87-91.
• 3. Cavanagh PR, Rodgers MM, Iiboshi A. Pressure distribution under symptom-free feet during barefoot standing. Foot Ankle.1987;5:262-276.
• 4. Cavanagh PR, Ulbrecht JS, Caputo GM. Biomechanical aspects of diabetic foot disease: aetiology, treatment, and prevention. Diabet Med. 1996;13Suppl 1:17-22.
• 5. Skopljak A, Muftic M, Sukalo A, et al. Pedobarography in diagnosis and clinical application. Acta Inform Med. 2014;22:374-378.
• 6. Kharbanda PS, Prabhakar S, Chawla YK, et al. Peripheral neuropathy in liver cirrhosis. J Gastroenterol Hepatol. 2003;18:922-926.
• 7. Montano-Loza AJ. Clinical relevance of sarcopenia in patients with cirrhosis. World J Gastroenterol. 2014;20:8061-8071.
• 8. Melai T, IJzerman TH, Schaper NC, et al. Calculation of plantar pressure time integral, an alternative approach. Gait Posture. 2011;34:379-383.
• 9. Aref WM, Naguib M, Hosni NA, et al. Dynamic posturography findings among patients with liver cirrhosis in Egypt. Egypt J Intern Med. 2012;24:100-104.
• 10. Schmid M, Mittermaier C, Voller B, et al. Postural control in patients with liver cirrhosis: A posturographic study. Eur J Gastroenterol Hepatol. 2009;21:915-922.
• 11. Burkhard PR, Delavelle J, Du Pasquier R, et al. Chronic parkinsonism associated with cirrhosis: A distinct subset of acquired hepatocerebral degeneration. Arch Neurol. 2003;60:521-528.
• 12. Soriano G, Roman E, Cordoba J, et al. Cognitive dysfunction in cirrhosis is associated with falls: A prospective study. Hepatology. 2012;55:1922-1930.
• 13. Cote KP, Brunet ME, Gansneder BM, et al. Effects of pronated and supinated foot postures on static and dynamic postural stability. J Athl Train. 2005;40:41-46.
• 14. Tong JW, Kong PW. Association between foot type and lower extremity injuries: Systematic literature review with meta-analysis. J Orthop Sports Phys Ther. 2013;43:700-714.
• 15. Chari VR, Katiyar BC, Rastogi BL, et al. Neuropathy in hepatic disorders. A clinical, electrophysiological and histopathological appraisal. J Neurol Sci.1977;31:93-111.
• 16. Chaudhry V, Corse AM, O’Brian R, et al. Autonomic and peripheral (sensori-motor) neuropathy in chronic liver disease: a clinical and electrophysiologic study. Hepatology. 1999;29:1698-1703.
• 17. Frith J, Kerr S, Robinson L, et al. Primary biliary cirrhosis is associated with falls and significant fall related injury. QJM. 2010;103:153-161.
• 18. Mathews S, James S, Anderson JD, et al. Effect of elastic bandage wraps on leg edema in patients before and after liver transplant. Prog Transplant. 2015;25:302-306.
• 19. Solà E, Watson H, Graupera I, et al. Factors related to quality of life in patients with cirrhosis and ascites: relevance of serum sodium concentration and legedema. J Hepatol. 2012;57:1199-1206.